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Home My Public Portal About5342 CAMELLIA AVE_Sewer__ {79AZ41D 6APPLICATION - FOR PERMIT a -OWISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL D.parhm.nf of Coant! Eapbn..r co,mir d Lw tea.. BUILDING WM.J. FOX, COUNTY ENGINKSM ADDRESS L CA&R TT 0. GRIFFIN, GUF'T OF NUILDI}10 LOCALIYT FOR APPLICANT TO FILL IN AREST. LEGAL � IO _ L DF�CRIPTION LOT N0. 1 O'RNRk BLOCK TRACT n V WAIL - DREff SIZE OF LOT NO. OF BLDGS. NOW ON LOT CITY y TEL. RO. USE OF BUILDINGS - T 1r illy CT NO. /GJRROUP YAP —7—a�/• I ••+f I BK FG CONTRACTOR JJ u ADDRESS C0Nff=0If DATA CITY TIL. NO. DEPTH q { ANHO RIFERENCIREGIfTRA710N X0. O�•�/ ❑ CLPE OF CONNECTION LENGTH FROM p0 No. DESCRIPTION OF WORK FEE OYWf1 ii15l?__ Y.L.TO P.L. V _ HOUSE SEWER CONNECTING TO PUBLIC SEWER- 3.30 HOUSE SEWERONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR Co. IMP. NO• JOB. No. � WORK TO HOUSE SEXIER 1.00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DIECQNNECT AND ABANDON SEWER !TATE EIICROACHYENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL • CESMPOOL-DRYWELL ' PASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGED CONNECTION CHARGE FEE ovnaw$ p� S 1 00 AOTHOBMATION F•t& FEE -V REIYBURSEYEXT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINQ DWELLING APPROVALS DATE IN VECTOR'S SIGNATURE TO THE PUBLIC SEWER NEW HOUSI SEWER SIGNED THIS DAY OF 19_ OWNER OR CONNECT ADDITIONAL OWNERS AGEXT BUILDING OR WORK SEPTIC TANK,SEEP,PIT(f) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKN7pyLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWILL❑ AND STATE THAT THE ABOVE 15 CORRECT AND AGRIE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWER➢, ALTER, REPAIR,fi11ERR OSEWAGE DISPOSAL SEWER OR 1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND EM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT HOUSE■EWER- CALIFORNIA OR THAT 1 AN THE LEGAL OW OF THE ASOV DESCRIBED R"IDQiTIAL PROPSYTY. SACKFILL TANKS oll r SIEP.PIT(9) MWOW SIGNATURE! OF-PtQ Y I TTEE ' WILLIAM J.FOX Cou IzNau+m VAI.MAWN —,-ToO 2 9 Y r FEB �7 4 450 0 a n _ DEPUTY /fes DEPUTY :1Y I J DEPUTY DEPUTY DEPAST3F91lvT OF COUNTY EN(RT&&R SEWER^SEWAGE DISPOSAL 1 DIVISION OF BUELDING AND SAFETY PERMIT APPLICATION • ' "COUNTY OF 1,09 ANG1111�9 WILLIAM J. FOX, CIIUN-Y ENGINEER BUILDING ADDRE8S FOR APPLICANT TO RLL IN LOCALITY BUILDINGMEAREBT AD DRESS CJ m ST. LOOALm, DISTRICT NO. SERIAL NO. PERMIT N0. c NEARREST A S CRO98 ST. RECEIVED BY RsaSy for Irs+sstlom DATE ISBUEU OWNER G. MAIL USE ZONE OOOUPANOY MAP M ADD eu RK CITY CONTRACTOR -4,ezelCO.IMT'.N0. i ADDR[p JOG M0. i OTIY T[ TRUNK PERMIT NO. STATE REGISTRATION NO. COUNTY ROAD PERMIT NO. LEGAL ol STATE ENCROACHMENT DESORIPTION LOT N0. PERMIT NO. GLOOK TRACT INDUSTRIAL WASTE APPROVAL 612[OF LOT N0.OF SLDQL CHARGE8 NOW ON LOT USE BUILD INGS CONNECTION CHARGE FEE NO- DESCRIPTION OF WORK FEE REIMBURSEMENT FEE PUBLIOSEWER 1 TO0 s Lu RECEIPT N0. DATE BY HOUSE SEWER OONNEONG TO. PRIVATE DISPOSAL SYSTEM 1.110 (301INEOT ADDITIONAL BLIJQ.09 EXCEPTION RECORDED WORK TO HOUSE SEWER Im N0. ER OR REPAIR I G DATE BY SEWER OR DISPOSAL SYSTEM 1.99 DISO&NNEOT AND ABANDON EQ __AND/OR DIBPOSAL SYSTEM 1.M CONNECTION DATA SEPTIC TANK,attPAG9 PIT OR PITSAND ORDII NFI[LD LSS STATION DEPTH BPEOIAL OONDOESSIPOOL-aIIT ONS OM Y 2M MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNER-$ PERMIT $ I 00 Y. CURB P.L. M.L.TO P.L. AUTHORIIAtION TOTAL FEE TRACTOR TO OONNNECTHAVE CTED WITH THE "LrRI"N NAMED COHE ABOVE DES¢RIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DAT[ DWELLING TO THE PUBUD SEWER SIGNED THIS nAY OP 19_ NEW HOUSE SEWER ER OR 9 OONNECT ADDITIONAL OWNERS AGENT 1 + •� '�'t-p' 13UILDING ORRK WORK OWN ADDRESS� 1' �L �_ C6 6.11-A- � AND/OR DRAINF QLD PIT(G) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL� CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO 00MPLY WITH ALL COUNTY ORDINANCES AND STAT[ LAWS :LTE R P p,SSW[R OR REGULATING PLUMBING AND SEWERS. SEWA�E DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGIMRED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT H PLUG AND AND STAT[ OF CALIFORNIA OR THAT I AM THE LEGAL 0 EWER ER OF THE ABOVE D IBRD BLWDH11�14—PBOP[NTY. BACKFI LL SEPTIC TANKS❑ SIGNATURE SEEP.PIT(S)E] OESSPOOL6[] OFp PERMITTEE 76 L42 M T/63 : aa"711.54 APPLICATIONFOR PERMIT , ` • ;.1. DriMON OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L Countr of Los A.9 fEUILDING aL +� WM.J. FOX, COUNTY ENGIN<[R ADDRESS T mac. CA"ATT D. GRIFFIN,1UT'T OF RIUrLDINO LOCALITY FOR CANT TO FILL IN NE�EfT CRO I ST, LEGAL 4F./O9i TId F5.66,f"'y bESCRIPON LOT 0. OWNER BLOCK TRACT MAIL" JID D q No.OF BLDG!L IIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF UILDIMGS OIyTR O. I 6ROU-P I MA CONTRACTOR JII BK �G ADDRESS COM(ECFION DATA CITY TEL,NQ. STATION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION MO. ❑ COUNTY UPPER LOWER TYPE OF CON XEQT LEN QjefzR0Y 11o. DESCRIPTION OF WORK FEE Y: CURB Y. O P.L HQUSE SEM CONNECTING TO PUBLIC SEWER $ 9.50 HOUSE SEVER CONNECTING TO 'PRIVATE DISPOSAL BY97-EM 1.00 CO XECT ADDITIONAL BLDG. OR CO. IMP.N0. JOB. NO. WORK TO HOUSE SEWER 1.00 ALTER OREPIC R EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT ROAD PERMIT DlSCONNEC AND ABANDON SEWER 6TATE ENC RESENT AHD/OR ISPOPAL SY9TE11 1.00 PERMIT SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 IRIAL D SPOQL- D YWELL "XAPPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEZ , ".� /• �7d � $'$ PE UT $ l 00 oe AUTHORI7ATION TOTAL FEE REIMBURSEMENT FEE I HAVE THIS DATE COX'fF�ACTHD WITH TTFF{{ HEREIN l�AHED CON- `r��TT� TRACTOR TO CONNECT THE ABOVE DESIRl%[) EXISTING DWELLING AMOVALS LS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC 59-*ER SIGNED THIS SAY OF 19 NEW HOUSE SEWER OWNER OR dONMECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC T"K, S P,PIT(fa ADDRESS - AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE WD THIS AFPLipalOX CE8JPOOj.❑ DRYWrLL4❑ AND HATE THAT THE ABOVE IS CORRECT AND A9RE9 TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAW$ REGULATING ALTER, REPAIR BIW-"ER OR PLUMBING AND SEWER11. SEWAGE DllPaAL SYSTEM I H -By CERTIFY THAT I AM PROPERLY RKGISTERRFD AA��11D/OR LICENSED AA REOU RED BY L09 ANGELES COUNTY AVIS tTATE OF DISCONNECT PLUG AND CA.LIFORNI11TH T I AY THE L"AL OWNE2 OF THE ABOVE ABANDON HOUfE$EWER DESCRIBEDR!•iilDKJI�I P G SEE". ,TS C Tom[] {IGMATURK J LJ OF.PERYIT. WILLIAM J. FOX.CcumTY I[Nai K9R VALIDATION � T DIEP UT7 f * DEPUTY ,.'NT BT i m DEPUTY DEPUTY